A practice in the North East Lincolnshire area

3. Mrs O complains that the Practice failed to correctly treat and investigate her mum’s, Mrs A, leg pain.

4. As a result, Mrs A developed a DVT and sadly died. Mrs O says her family has lost their mum, wife and grandmother.

5. Mrs O is seeking an apology and service improvements.

6. Mrs A went on holiday in August 2023. On her return she began experiencing painful swelling in her right leg. She visited her GP on 31 August, 6 September and 15 September.

7. On 18 September, Mrs A sadly died from a pulmonary embolism caused by deep vein thrombosis (DVT).

11. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

12. Mrs O says the Practice failed to recognise Mrs A’s leg pain and swelling as a DVT (deep vein thrombosis, is a blood clot in the leg). Mrs A sadly died on 18 September as she had an untreated DVT which led to a cardiac arrest.

13. Mrs A visited her GP on 31 August 2023 with painful swelling to her leg. The GP did several tests and told her she had a DVT. She was prescribed apixaban (apixaban is an anticoagulant used to treat blood clots). The GP referred her for an urgent ultrasound scan (a scan that creates an imagine of part of the inside of the body).

14. The NICE guidance on the management of DVTs says doctors should use the Wells score to assess whether a person has a DVT. The Wells score is a tool that assesses the likelihood of a DVT based on the results of clinical tests.

15. The NICE guidance says doctors should assess a patient’s medical history and do a physical examination to exclude other causes for the swelling. The GP measured Mrs A’s calves and noted that her right calf was 43cm with swelling and her left calf was 37cm, a 6cm difference.

16. The assessments revealed a Wells score of two. The Wells score is a tool that assesses the likelihood of a DVT based on the results of the examination. The Wells score sets out clinical features such as calf swelling more than 3cm bigger than the non-swollen leg, entire leg swelling, recently bedridden for more than three days amongst others. Each clinical feature identified receives a point, which is then used to determine a Wells score.

17. The NICE guidance says a score of two or over, indicates DVT is likely. The guidance recommends an urgent ultrasound scan within four hours, followed by a D-dimer test, if the result is negative. If an ultrasound cannot be arranged within four hours, the guidance says patients can be offered a D-dimer test (a D-dimer test measures a protein fragment that indicates blood clot formation and breakdown).

18. The GP also completed a D-dimer test (a test used to indicate blood clots in the body) which showed a positive result indicating Mrs A had a DVT. The GP had followed all relevant guidance at this point.

19. Mrs A had an ultrasound scan later that day. This scan showed no DVT and instead states ‘possible cellulitis’. Cellulitis is a skin infection that usually affects the legs and causes painful swelling. The GP advised Mrs A to stop taking the apixaban and was treated for cellulitis instead.

20. Mrs A visited her GP again on 6 September as she was still having issues with her leg. The records from this appointment state that the swelling in her leg had reduced and she reported her pain was 40% better. The GP prescribed her further antibiotics to treat the cellulitis, and pain killers. The GP advised Mrs A to return in two weeks if her symptoms continued.

21. Mrs A went back to the GP again on 15 September. The GP carried out further blood tests which showed normal results and showed no explanation for Mrs A’s continuing symptoms. The notes from this appointment state the Practice had examined Mrs A and seen no evidence of DVT. The records not the Practice planned other tests to look for secondary causes of the swelling to Mrs A’s leg.

22. Mrs A sadly died on 18 September in hospital, from a pulmonary embolism caused by a DVT. Mrs O believes the Practice could have done more to identify her mums DVT and potentially save her life.

23. We asked our adviser whether the Practice could have done more to prevent Mrs A’s DVT worsening. Our adviser told us that on 15 September it appears the Practice were continuing investigations into the potential causes for Mrs A’s pain and swelling.

24. Mrs A had further, more in depth tests at this appointment and the plan was to review the results and consider treating her with diuretics (medication that reduces fluid retention) to aim to reduce the swelling in her legs.

25. Unfortunately, Mrs A passed away three days after these tests and the Practice did not have the opportunity to follow up on the test results with Mrs A. Prior to her death, the Practice had acted appropriately in its treatment and management of Mrs A’s symptoms.

26. We have seen evidence the actions the Practice took were in line with the guidance, given Mrs A’s D-dimer, Wells score and ultrasound scan results. The GP suspected DVT based on initial test results and reacted to further test results that indicated cellulitis and not DVT.

27. Upon reviewing all available and applicable evidence, we have not seen any indication that the Practice has acted inappropriately.

28. We recognise the distress this has caused to Mrs A’s family. We appreciate that Mrs O feels the Practice could have done more to prevent her mum’s death, we hope this statement reassures her that the Practice acted in line with national guidance.

29. We will be taking no further action.

1. We have carefully considered Mrs O’s complaint about a practice in the North East Lincolnshire area (the Practice). We recognise the distress these issues have had on Mrs O and her family. We were very sorry to hear the circumstances surrounding the complaint.

2. We have decided not to consider Mrs O’s complaint further. This is because we have seen no indication the Practice got anything wrong. We have explained the reasons for this below.